Operative Therapiemöglichkeiten in der Lymphologie

Zusammenfassung

Das Lymphgefäßsystem ist essenziell für den Rücktransport interstitieller Flüssigkeit aus dem Gewebe zurück in den Blutkreislauf. Bei Störungen des komplexen Netzwerkes kommt es zur Ausbildung von Ödemen und der Ansammlung und Ablagerung von Proteinen und Lipiden in der betroffenen Region. Obwohl das Lymphsystem schon seit Jahrhunderten Gegenstand der Forschung ist, haben lymphologische Krankheitsbilder wie das Lymphödem als mögliche Folge onkologischer Therapien erst in den vergangenen Jahren an Aufmerksamkeit gewonnen. So liegt die Inzidenz des sekundären Lymphödems, das durch traumatische, infektiöse oder iatrogene Schädigung auftritt, zwischen 0,13 und 2 % und betrifft meist Frauen. Auch das davon abzugrenzende Lipödem ist in den letzten Jahren zunehmend in den Fokus der Öffentlichkeit gerückt. Beide Erkrankungen können mit einer schmerzhaften Umfangsvermehrung, einer beruflichen und alltäglichen Einschränkung und einer Reduktion der Lebensqualität einhergehen. Neben der klinischen Untersuchung und Anamnese gewinnen neue bildgebende Verfahren eine zunehmende Bedeutung zur Verbesserung der Diagnosestellung, Stadieneinteilung und Therapieplanung, wenngleich immer noch oftmals Monate bis Jahre bis zur korrekten Diagnosestellung vergehen. Während konservative Therapiemethoden wie die komplexe physikalische Entstauungstherapie weiterhin die Grundlage der Behandlung bilden, kommen zunehmend auch operative Verfahren bei der Therapie des Lymphödems zum Einsatz. Hierbei unterscheidet man die reduzierenden Verfahren, die hauptsächlich auf die Symptomreduktion abzielen, von den rekonstruktiven Verfahren zur Wiederherstellung des Lymphsystems mittels mikrochirurgischer Techniken. Nachfolgend werden verschiedene operative Therapiemöglichkeiten in der Lymphologie dargestellt.

Abstract

The lymphatic system is essential for the transport of interstitial fluid back into the vascular system. Disturbance of the complex network can lead to edema and the accumulation of proteins and lipids in the affected body region. Even though the lymphatic system has been a topic of intense research for centuries, lymphological diseases like lymphedema as a possible secondary effect of oncological treatment only recently gained attention. Secondary lymphedema can have traumatic, infectious or iatrogenic causes and mainly affects women with an incidence of 0.13–2 %. The lipedema is another disease with increasing public interest in recent years but should be differentiated from lymphedema. Both diseases can involve painful circumferential growth, limitations in the professional and private daily routine and lead to a reduced quality of life. Beside clinical examination new imaging techniques are of increasing importance for the diagnostic procedure, the staging and the planning of treatments. However, in many cases it takes months or even years until the correct diagnosis is found. While therapy is still based on conservative treatment options like the complex manual decongestion therapy, surgical treatment options are increasingly used for patients with lymphedema. Reducing surgical methods are mainly leading to a decrease of symptoms whereas reconstructive surgical techniques aim to reconstruct the lymphatic system using microsurgery. In the following, various surgical therapy options in lymphology are presented.

Schlüsselwörter

operative Lymphologie - LVA - VLNT - Liposuktion

Key words

surgical lymphology - LVA - VLNT - liposuction

Publikationsverlauf

Artikel online veröffentlicht:
29. Juli 2021

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